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The Canadian Task Force on Preventive Health Care (CTFPHC) is composed of experts who develop recommendations for clinical preventive services delivered by Canadian primary care practitioners. The CTFPHC is responsible for prioritizing the topics that will be reviewed and works with the Global Health and Guidelines Division (GHGD) of the Public Health Agency of Canada to define the analytic framework and scope of each topic. In the preparation of evidence reviews and the development of recommendations for each topic, the CTFPHC collaborates with two evidence review and synthesis centres and the GHGD. The CTFPHC also leads knowledge translation (KT) activities to promote guideline reach and uptake.

Message From the Chair

Greetings! In this issue, I am pleased to announce the release of our newest clinical practice guideline. In February 2017, the CMAJ published the CTFPHC’s Recommendations on behavioural interventions for the prevention and treatment of cigarette smoking among school-aged children and youth. For more information about the tobacco guideline, systematic review, and associated KT tool, please visit the CTFPHC tobacco guideline page.

As always, we appreciate your interest in the CTFPHC and we encourage you to stay up to date on our work by visiting our website at www.canadiantaskforce.ca.

Sincerely,
Marcello Tonelli, MD SM
Chair, CTFPHC

Release of the CTFPHC’s Tobacco Prevention and Treatment Guideline

The CMAJ published the CTFPHC’s thirteenth guideline in February 2017. This latest guideline addresses tobacco prevention and treatment in school-aged children and youth (ages 5 – 18 years).

Among Canadian youth, 18% have tried cigarettes. Approximately 90% of adult smokers first smoked tobacco by age 18 and people who start smoking as children or youth are less likely to quit later in life than people who start later. A variety of factors, such as age, sex, and peer and environmental influence, are linked to a youth’s decision to begin smoking. Health risks related to tobacco smoking include cardiovascular and respiratory diseases, and half of regular smokers will die
prematurely.

Based on available evidence, the CTFPHC recommends asking children and youth or their parents about tobacco use by the child or youth and offering brief information and advice as appropriate during primary care visits to prevent the initiation of tobacco smoking. These recommendations apply to children and youth who do not currently smoke tobacco, have never smoked, or are former smokers. For children and youth who have smoked in the last 30 days, the CTFPHC recommends treating tobacco smoking by asking the child or youth or their parents about tobacco use and offering information and brief advice during primary care visits. These are both weak recommendations based on low-quality evidence.

The CTFPHC based its recommendations on the potential moderate reduction in smoking initiation, the modest increase in the likelihood that youth will stop smoking, the similar size effect of low- and high-intensity interventions, and the high likelihood that harms of preventive or treatment interventions are minimal. The recommendations are weak because of low certainty that evidence reflects the true effect of the behavioural interventions (for both prevention and treatment of smoking) and the lack of evidence that any benefit, if present, would be sustained.

Parents who are concerned about the potential for their child or youth to start smoking may choose to participate. However, they may choose to decline based on the limited evidence available or if the risk of smoking is low for their child. The CTFPHC encourages primary care providers to help each child/youth or
family make a decision that is consistent with their values and preferences.

Resources

To accompany the tobacco guideline, the CTFPHC has developed a clinician FAQ sheet. The FAQ sheet provides answers to common questions that clinicians may have about tobacco prevention and treatment in school-aged children and youth. Copies of the clinician FAQ are available to download for free on the tobacco guideline page on the CTFPHC website.

Announcements

New CTFPHC Website

The CTFPHC is pleased to announce the launch of our new website!

We have redesigned the old CTFPHC website based on last year’s annual evaluation results. The changes were aimed at making it easier for users to navigate the website and find the guidelines and tools they are looking for.

We designed the new CTFPHC website to be more mobile friendly. For this reason, we will no longer update the CTFPHC mobile app with new content. Primary care practitioners can still easily access CTFPHC content on the CTFPHC website through the Internet browser on their mobile device.

GRADE Update

The CTFPHC develops its guidelines using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) method. This is an internationally recognized method for evaluating systematic review evidence to develop clinical practice guidelines.

As part of its KT activities, the CTFPHC is conducting a project to identify the best ways to organize and present guideline recommendations and content to Canadian primary care practitioners. Interviews with primary care practitioners are now complete. Data analysis of findings is in progress and the results
will inform how the CTFPHC presents recommendations and guideline information in its guidelines and KT tools.

Opportunities for Engagement

Patient Engagement in Guideline Development

The CTFPHC now engages patients in its guideline development process. Specifically, the CTFPHC recruits patients to provide input at up to two stages of the process: (1) when outcomes are selected for inclusion in the systematic review protocol that informs the guideline and (2) when the guideline recommendations are developed. The CTFPHC uses feedback provided by patients to guide the search for evidence on the harms and benefits of preventive health care interventions and to develop KT tools to accompany the guidelines.

Usability Testing of Practitioner Tools

The CTFPHC produces practitioner tools to support each of its guidelines. To ensure that the content, layout, navigation, and aesthetics of these tools are appropriate and useful for practice, we conduct usability testing with practitioners. If you are interested in reviewing and providing feedback on one of our upcoming guideline tools, please email Kavitha Thiyagarajah, research assistant, at thiyagarajak@smh.ca for more information. Note that we offer $100 compensation for a one-hour telephone interview.

Usability Testing of Practitioner Tools

The CTFPHC produces practitioner tools to support each of its guidelines. To ensure that the content, layout, navigation, and aesthetics of these tools are appropriate and useful for practice, we conduct usability testing with practitioners. If you are interested in reviewing and providing feedback on one of our upcoming guideline tools, please email Kavitha Thiyagarajah, research assistant, at thiyagarajak@smh.ca for more information. Note that we offer $100 compensation for a one-hour telephone interview.

Guidelines in Progress

Forthcoming guidelines developed by the CTFPHC will focus on the following topics:

Screening for hepatitis C

Screening for abdominal aortic aneurysm

Screening for asymptomatic bacteriuria in pregnancy

Screening for impaired visual acuity

Screening for esophageal cancer

Topic Suggestions

Is there a preventive health topic that you would like to see the CTFPHC develop a clinical practice guideline for? Let us know what you are passionate about! We accept topic suggestions on a rolling basis and would love to hear from you. To submit a suggestion, please email us at info@canadiantaskforce.ca with the subject line “Topic Suggestions”.

Suggestions for the Next Newsletter

Is there a subject that you would like to see addressed in the next issue of the CTFPHC newsletter? Let us know what you’d like to see covered! We accept suggestions on a rolling basis.

To submit a suggestion, please email Kavitha Thiyagarajah, research assistant, at thiyagarajak@smh.ca with the subject line “Newsletter Suggestions”.

Before each meeting, every member of the Canadian Task Force on Preventive Health Care (CTFPHC) and of the Evidence Review and Synthesis Centre (ERSC) completes a Declaration of Affiliations and Interests Form to report any potential conflicts of interest (e.g., financial, business or professional, intellectual). Disclosure is required for each new topic, and disclosures must be updated to reflect any changes that have occurred since an initial disclosure. Completed forms are kept on file, and outside experts who are asked to comment on the recommendations and documents prepared by the CTFPHC are also required to complete disclosure forms, which are kept on file. For more information, please refer to the CTFPHC’s Procedure Manual.